How symptoms effect healthcare utilization and cost in older adults receiving home healthcare.

In healthcare, we tend to focus on the patient’s disease, rather than symptoms, though symptoms are central to the patient experience. Symptoms have been found in other settings to be poorly recognized and managed, yet drive healthcare utilization, cost, and patient satisfaction. In home healthcare (HHC) symptoms have not been deeply explored. We examined a 5% sample of 2011–2012 Medicare OASIS, MEDPAR, and Carrier file data (N=2,061,168) to better understand how symptoms effect care. Chi-square analysis showed patients with more severe dyspnea and behavioral symptoms, but not pain had significantly higher rates of utilization and cost (p<.0001). In multivariate analyses readmission at 30-days was significantly greater in severe dyspnea (OR=3.06, p<.0001) and behavioral symptoms (OR=1.34, p<.0001) but NS for pain. When comparing to other studies, this indicates that pain is likely under-reported in HHC, and there is significant room for improvement in assessment and management of symptoms in this setting.